Suturing tissue laparoscopically has always been challenging. Over the past fifteen years or so, there have been many devices developed and marketed to solve this problem. Linear staplers have been the most successful of these devices, but they have limitations. One of the limitations of stapling devices is that one can only place the staples in a pre-determined, confined, straight row. Other stitching type or needle-passing type devices also have been marketed with limited acceptance. Needle management is one concern with these devices. Needle manipulation and knot tying difficulties in confined spaces also have presented concerns. Surgical fasteners or clips, which address suture knot tying problems, are disclosed, for example, in U.S. Pat. No. 6,607,541 to Gardiner, et al., U.S. Pat. No. 6,514,265 to Ho, et al., U.S. Pat. No. 6,613,059 to Schaller, et al. and U.S. Pat. No. 6,641,593 to Schaller, et al. There remains a need to improve apparatus and methods for joining structures in surgical procedures.